Proposed algorithm for the management of athletes with athletic pubalgia (sports hernia): a case series

J Orthop Sports Phys Ther. 2008 Dec;38(12):768-81. doi: 10.2519/jospt.2008.2846.


Study design: A case series of 6 athletes with a suspected sports hernia.

Background: Groin pain in athletes is common, and 1 source of groin pain is athletic pubalgia, or a sports hernia. Description of this condition and its management is scarce in the physical therapy literature. The purpose of this case series is to describe a conservative approach to treating athletes with a likely sports hernia and to provide physical therapists with an algorithm for managing athletes with this dysfunction.

Case description: Six collegiate athletes (age range, 19-22 years; 4 males, 2 females) with a physician diagnosis of groin pain secondary to possible/probable sports hernia were referred to physical therapy. A method of evaluation was constructed and a cluster of 5 key findings indicative of a sports hernia is presented. The athletes were managed according to a proposed algorithm and received physical therapy consisting of soft tissue and joint mobilization/manipulation, neuromuscular re-education, manual stretching, and therapeutic exercise.

Outcomes: Three of the athletes received conservative intervention and were able to fully return to sport after a mean of 7.7 sessions of physical therapy. The other 3 athletes reached this outcome after surgical repair and a mean of 6.7 sessions of physical therapy.

Discussion: Conservative management including manual therapy appears to be a viable option in the management of athletes with a sports hernia. Follow-up randomized clinical trials should be performed to further investigate the effectiveness of conservative rehabilitation compared to a homogeneous group of patients undergoing surgical repair for this condition.

Level of evidence: Therapy, level 4.

MeSH terms

  • Adult
  • Algorithms*
  • Athletic Injuries / diagnosis
  • Athletic Injuries / prevention & control
  • Athletic Injuries / rehabilitation*
  • Diagnosis, Differential
  • Exercise Therapy
  • Female
  • Groin / injuries*
  • Groin / pathology
  • Hernia, Inguinal / diagnosis
  • Hernia, Inguinal / prevention & control
  • Hernia, Inguinal / rehabilitation*
  • Humans
  • Male
  • Rehabilitation Centers
  • Treatment Outcome